Influenza A (H1N1)

INFLUENZA PANDEMIC (H1N1) 2009

Most recent posts

February 2010 ~ The WHO is likely to recommend inclusion of the pandemic (H1N1)
2009 strain in future vaccines for seasonal influenza.

ProMed quotes the World Health Organization flu chief,Keiji Fukuda, : "This is a period in which we
consider that the pandemic is still continuing... We hope that the worst is over, but you can't
suddenly let down your guard."
There have been over 15 000 laboratory confirmed deaths worldwide
since the swine flu outbreak began in North America last spring
[2009]. WHO says the actual death toll is probably much higher, but a
final figure won't be available for 1-2 years.

February 2010 ~ H1N1 virus present in animals in twenty countries

In the North West of France, H1N1 is found in turkeys. The 8,500 animals are being kept in quarantine.
With this finding, France is the twentieth country that has detected H1N1 in animals. In all cases, the animals were infected by humans with flu characteristics. The disease symptoms in animals are mild.
The virus has been found in animals in Canada, Australia, Chile, UK, Ireland, Norway, Japan, Iceland, Indonesia, Finland, USA, Italy, Mexico, Thailand, Korea, Russia, Denmark, Argentina, Serbia and France.
The World Organisation for Animal Health (OIE) watches over the risks that the virus is transmitted via meat consumption. The OIE advises to keep the control of the virus running to get a good insight of the spreading of the virus.

December 10 2009 ~ "a key plank of the evidence for Tamiflu's effectiveness is being called into question.

The anti-viral drug Tamiflu was hailed as a first line of defence against the A/H1N1 epidemic. The claim was that Tamiflu could reduce the hospitalising of patients with swine flu by up to 60 per cent.
However, ProMed warned in August about the "continued profligate use of Tamiflu in the treatment of mild
infections.." In the UK alone the estimated bill for Tamiflu is approaching half a billion pounds. Channel 4 News revealed on Tuesday that serious scientific questions are being raised over the evidence base for Tamiflu. A review published in the British Medical Journal accused Tamiflu's manufacturer, Roche, of withholding evidence from trials. Roche has made a fortune out of the drug. The reviewers say it is possible Tamiflu reduced the risk of pneumonia but if so, the benefit was small and there were side-effects to consider.
Professor Nick Freemantle said he saw

"very little evidence to support the widespread use of oseltamivir in the otherwise healthy population who are developing signs of influenza-like illness. We have remarkably few resources in this country to spend on pharmaceuticals on health, and it is surprising to see such widespread use of oseltamivir. But I suppose that once you've gone and bought lots of doses, then it's a bit like the situation with gun control in the US. If you have a gun in the house, it is much easier to use it. But it does not mean it's the right thing to do."

Dr Godlee and Professor Mike Clarke, director of the UK Cochrane Centre, call in the BMJ for new global legislation to ensure all trial data on drugs that have been granted a licence must be published in full. Read more at www.guardian.co.uk

December 2 2009 ~Swine flu confirmed in pigs
on a farm in Norfolk

The case is the sixth incidence of the strain of H1N1 in pigs in the UK, following cases in Northern Ireland. See teletext

December 2 2009 ~ "It appears as if we may see continuing, if not increasing, numbers of
reports of "reverse transmission" of this zoonotic disease from humans
to animal species."

H1N1 has now been recorded in cats, ferrets, geese and now there is a case in Finland concerning a pig farm where the farmers had with flu-like symptoms
a few days before the pigs became unwell with lack of appetite, fever and mild
respiratory signs and showed A/H1N1 on RRT/PCR. All the pigs recovered fully in 1-2 days. The farm is under voluntary
restrictions. See ProMed report. The moderator comments, "As these reports accumulate, we should take the
opportunity to determine why they occur and what are the risk factors
for the "reverse transmission" on both farms and households where
other animal species are being infected."

November 29 2009 ~ Dogs test positive to H1N1 in China

See ProMed posting here. The moderator (AS) comments: "This adds another animal species to those already known to become
infected by the influenza pandemic H1N1 virus. Thus far, pigs,
turkeys, ferrets and cats have been reportedly infected. Most
probably, those animals were infected from humans, though further
animal-to-animal infection is, obviously, not excluded."

The Washington Post says this is "no more than would normally be expected in that number of people. About 80 to 160 cases of the condition occur each week in the United States, usually after an infection." The paper also reports on the CDC's monitoring of severe reactions to the H1N1 vaccine. "The agency's reports thus far have been "extremely reassuring,"...with the pattern and severity of problems "pretty much what we see for seasonal flu vaccines." About 94 percent of reactions reported to the government are classified as "not serious," with soreness at the injection site the most common." The headline to the article: CDC connects H1N1, severe bacterial infections
Rise in cases expected alongside flu pandemic; Denver is hotbed.

November 21 2009 ~ WHO is assessing the importance of a mutation

The Norwegian Institute of Health has been analyzing H1N1 virus from "a number of patients as part of the surveillance of the pandemic flu virus, and has detected several mutations. While the existence of mutations is normal, one mutation has caught special interest."According to the World Health Organization Pandemic (H1N1) 2009 briefing note 17 on Friday

"...
Norwegian scientists have analysed samples from more than 70 patients with clinical illness and no further instances of this mutation have been detected. This finding suggests that the mutation is not widespread in the country.
The virus with this mutation remains sensitive to the antiviral drugs, oseltamivir and zanamivir, and studies show that currently available pandemic vaccines confer protection.
Worldwide, laboratory monitoring of influenza viruses has detected a similar mutation in viruses from several other countries, with the earliest detection occurring in April. In addition to Norway, the mutation has been observed in Brazil, China, Japan, Mexico, Ukraine, and the US.
Although information on all these cases is incomplete, several viruses showing the same mutation were detected in fatal cases, and the mutation has also been detected in some mild cases. Worldwide, viruses from numerous fatal cases have not shown the mutation. The public health significance of this finding is thus unclear.
....
Although further investigation is under way, no evidence currently suggests that these mutations are leading to an unusual increase in the number of H1N1 infections or a greater number of severe or fatal cases..." Read in full

It is, of course, impossible for the layman to know what is really going on. However, it seems that some consider that the D222G (otherwise known as D225G) mutation may be allowing the virus to bind to receptors on cells lining the lungs, cells which are slightly different from those in the nose and throat. Henry L. Niman, a flu tracker in Pittsburgh, has been warning for a week on Twitter that D225G has been repeatedly found in Ukraine, which is in the grip of a severe outbreak. According to Niman, a surprising number of people have died with lung haemorrhages. He cites recombinomics.com (very technical). ProMed however, with its many rapporteurs, has not yet shown concern about a possibly more fatal mutation. We consider this reassuring. (ProMed's posting Nov 21)

The BBC item, mentioning that on Thursday [19 Nov 2009] it was announced that more than 3 million
healthy children under 5 across the UK will be offered the swine flu
jab. also reported a general drop in reported cases.
However, the BBC news item also mentions that in Wales, what ProMed calls "the 1st unequivocal occurrence of transmission of
Tamiflu-resistant influenza pandemic (H1N1) 2009 virus from person to
person" has taken place. However, " the circumstances of transmission are not revealed in
this report and this observation may have little relevance to the
situation in the general community."

November 19 2009 ~ "the latest weekly bulletin showed a sharp rise in patient deaths and the number of children being admitted to hospital."

Guardian: " Health officials estimate there were 55,000 new cases this week in England compared with 64,000 last week. There was a slight drop in Scotland.
The number of people who have died from swine flu in the UK has reached 214. There were 18 deaths in England last week. The figures since the start of the outbreak in May are 142 fatalities in England, 21 in Wales, 38 in Scotland and 13 in Northern Ireland.
The number of people needing hospital care for the virus is 783, down slightly from 785, in the previous week. Of those in hospital, 180 were in intensive care, up from 173 in the previous week. ..."

November 18 2009 ~ Ukraine: WHO report - "As of 17 Nov 2009, preliminary tests reveal no significant changes in
the pandemic (H1N1) 2009 virus based on investigations of samples
taken from patients in Ukraine..."

".. Analyses are being performed by 2 WHO
influenza collaborating centres as part of the global influenza
surveillance network." ProMed comments: ".. This statement from WHO has scotched some of the wilder rumours
regarding the identity of the agent responsible for the current
outbreak of influenza and acute respiratory illness in Ukraine. The
genome sequencing analyses carried out in the UK and the USA indicate
that the Ukrainian outbreak is an extension of the 2009 pandemic of
H1N1 influenza spreading eastwards through Europe and beyond."

November 16 2009 ~ Ukraine: ".. still unclear to what extent pandemic (H1N1) virus infection is
responsible for this situation," says ProMed

While today's Express seems shamelessly to exploit the situation by talking of "a deadly plague" that could "sweep across Europe" and "a state of panic", the ProMed moderator on Friday said,

"...numbers from official and semi-official sources in the Lviv
region of Ukraine are confusing. Undoubtedly there has been a large
number of people in the Lviv region of Ukraine affected by unspecified
flu or acute respiratory infections, and a large number of fatalities.
It is still unclear to what extent pandemic (H1N1) virus infection is
responsible for this situation."

Scientists at the Medical Research Council laboratories at Mill Hill are still testing samples from Ukraine to identify the pathogen and see if there is a mutated strain of influenza. (ProMed may be thought a more reliable source for accurate information than the Express or the Mail.)

November 8/9 2009 ~ "So far, no evidence has suggested that animals play any particular role in the epidemiology or the spread of the pandemic H1N1 2009 virus among humans." Bernard Vallat

From the OIE website: "The OIE is closely monitoring the world animal health situation including with regard to infections of all susceptible animals with the pandemic H1N1 2009 virus." Dr Bernard Vallat, OIE Director General is quoted:

"Pandemic H1N1 2009 virus infections in pigs and other susceptible animals were assessed as probable from the very first days after the virus was detected in humans. So, it does not come as a surprise that notifications of infection in new animals species are received; on the contrary it demonstrates animal disease surveillance is efficient and functioning to the benefit of all... As national Veterinary Authorities continue and intensify surveillance for the pandemic H1N1 2009 virus in susceptible animals, it is very likely that there will be additional findings of other influenza strains. That is why we insist on the importance of epidemiological investigations of unusual illness among all animals, and the necessary collaboration and communication between animal health and public health authorities..."

November 6 2009 ~ The World Health Organization has forecasted three waves of A/H1N1 flu in Ukraine and in the world

The head of WHO office in Ukraine, Ihor Pokanevych, told Deutsche Welle on Nov. 5 that the first wave is being observed now, the second will come next spring, and the third during the autumn of 2010. More detail at www.kyivpost.com

November 5 2009 ~ Cat with H1N1

"A 13-year-old Iowa cat has been infected with swine flu, veterinary and federal officials said Wednesday in what is believed to be the first case of the H1N1 virus in a feline in the United States.
The domestic shorthaired cat was treated last week at Iowa State University College of Veterinary Medicine in Ames and has recovered, officials said. The virus also has been confirmed in two ferrets - one in Oregon and the other in Nebraska - but they died.." Read in full.

It appears that two of the three people in the cat's Iowa home had flu-like symptoms before the cat became ill. The case was confirmed at both Iowa State and the U.S. Department of Agriculture.

November 2 2009 ~ H1N1: Grim situation in the Ukraine

"After 60 people died of respiratory problems in one week, Ukraine has made an urgent appeal to world powers to help it fight the swine flu. President Viktor Yushchenko has written to the United States, the European Union, NATO, and Ukraine's neighbors, asking for drugs and equipment to fight the spread of the A(H1N1) virus. .The country's health ministry said there are currently more than 190,000 cases of swine flu, with nearly 8,000 needing hospital treatment. The government has ordered a three-week closure of schools and cinemas to combat the disease. Poland and Slovakia responded immediately to Yushchenko's appeal on Sunday night and dispatched protective masks and supplies of Tamiflu.." Read in full

October 19 2009 ~ H1N1 " the largest vaccination campaign in Canadian history...but the public remains confused"

In Canada's Globe and Mail, an article today poses questions and gives answers about the virus and the vaccine. Meanwhile, Reuters reports that USDA has confirmed H1N1 in a show pig "..H1N1 flu virus was confirmed in a sample from a hog exhibited at the Minnesota State Fair, the Agriculture Department said on Monday. Additional samples are being tested."

October 16 2009 ~ Vaccination programme starts next week

The Independent reports that it will will cover almost 13 million people.
High-risk patients and frontline NHS staff will be offered vaccine in hospitals from 21 October. GPs are expected to receive their first doses for patients in the priority groups from 26 October. The number of deaths in the UK is 106 today. Sir Liam Donaldson is quoted on the proportion of hospitalised patients who have been in intensive care since the flu began.:"..... For most of the time it's been about 12 to 13 per cent, now it's up to 20 per cent, suggesting we are seeing more serious cases than we were seeing before. There is no sign of any change in the virus but this is giving me some concern."

October 6 2009 ~ "the Canadian experience is exceptional
and has not been observed elsewhere"

A Canadian study
that suggests people who get the normal flu vaccine are twice as
likely to contract H1N1 [pandemic 2009] virus infection is now considered "exceptional"
and has not been observed elsewhere. The WHO recommends that other countries
should not amend their vaccination strategies, say the ProMed moderator adding that the WHO Scientific Advisory
Group of Experts (SAGE) will review the situation later in the month.

.

October 6 2009 ~ Tamiflu in drinking water: ".. inevitable that society will need to devise ways of
conserving water by recycling our wastewater."

Dr. Andrew Singer
from the Centre for Ecology & Hydrology
in Wallingford writes to ProMed that it has been confirmed that oseltamivir carboxylate (OC)

"does not readily
biodegrade in the wastewater, thus allowing it to reach receiving
rivers. This effectively means that virtually all the Tamiflu being
consumed either for seasonal or pandemic use will pass through humans
into wastewater treatment plants and into our rivers..."

He says that although little of the
drug should reach the bloodstream, the influenza virus can "relatively easily generate resistance in
humans" and, in spite of the necessary investment involved, recommends the removal of
pharmaceuticals from rivers, including the "estrogens and
estrogen-mimicing chemicals constantly being released into our
rivers." Read in full

October 3 2009 ~ Birds are being exposed to waterborne residues of Tamiflu's active form and could spread drug-resistant strains of flu.

ProMed today highlights a report from Japan which shows that Tamiflu's
active form, oseltamivir carboxylate (OC), has been turning up in treated sewage:

"....concentrations
measured at some river sites in the new Kyoto study seem "high enough to
lead to antiviral resistance in waterfowl," Ghosh says. And the Kyoto team
didn't test during a pandemic, when Tamiflu prescription rates might be 10
times higher, von Tumpling notes. Indeed, the expected coincident hits by seasonal and H1N1 swine flu this
winter could send Tamiflu use skyrocketing.."

The cited report quotes the view of the chair of
preventive medicine at the Vanderbilt University School of Medicine that the "(H1N1) 2009 virus seems to bypass
birds as it spreads among people." The ProMed moderator says that so far there don't seem to have been any reports
of isolation of oseltamivir-resistant influenza virus directly from water
fowl - but, as we were warned in July, and have seen in the press many times since the UK government's widespread use of anti-virals has been viewed as inadvisable. The US Federal guidelines are to recommend that
"Tamiflu be reserved for treatment of the very sick and anyone who is
immunocompromised."

October 1 2009 ~ The Irish pigs contracted H1N1 from a farmworker

Ireland reported an outbreak of H1N1 in a pig breeding farm. Forty pigs were affected. Following confirmation of the virus in a worker on 22 September the pigs were being monitored as high-risk.
The worker tended the pigs whilst sick from 15-18 September. Clinical signs appeared in the pigs on 25 September with sows off feed and laboured breathing. Movements of pigs off farm have been stopped voluntarily since 18 September in accordance with a Code of Practice previously agreed between Department of Agriculture and stakeholders.
Source: OIE

September 26 2009 ~ "it appears as though the
southern hemisphere countries in the Americas are starting to see
decreased influenza activity, and northern hemisphere is beginning to
increase in activity

September 20 2009 ~ New wave already here?

Reuters UK "A rise in the number of English cases of the H1N1 influenza could indicate the start of a second wave of infections and two cases have shown resistance to the antiviral drug Tamiflu, health officials said on Thursday..." Read in full

September 20 2009 ~ European countries agreed to share vaccine this week under a European Commission plan.

Reuters reports too that "The United States pledged 10 percent of its vaccine supply, joining Australia, Brazil, France, Italy, New Zealand, Norway, Switzerland, and Britain.
The World Health Organisation has been working to persuade countries to share their supplies of vaccine against the pandemic. "They own most of the vaccine out there," WHO's Dr. Keiji Fukuda told scientists at an Institute of Medicine pandemic influenza meeting this week..."

September 20 2009 ~ Top 10 list of what's important to know includes "just ride it out and not take antiviral medications"

On CBS News we read a doctor's top ten list of what's most important to know, "much of it coming from the website of the Centers for Disease Control and Prevention, which has done a spectacular job of providing timely and useful information" The virus never really went away in America and is now surging much earlier than with the regular seasonal flu.
In August, a panel of experts prepared an extensive report (pdf) for President Obama. Last week the CDC said that most people who come down with the 2009 H1N1 flu should just ride it out and not take antiviral medications such as Tamiflu and Relenza. Dr. Anne Schuchat of the CDC said the majority of adolescents, adults and children "can be cared for with mom's chicken soup at home, rest, and lots of fluids." But she stressed the importance of early treatment with antiviral medications - within 48 hours if possible - for certain patients at increased risk of complications, especially those hospitalized, under age 5, over age 65, or with chronic medical conditions. Before last week, US doctors were advised to give such patients at high risk medication to prevent infection; now doctors are being given the option of "watchful waiting" - observing the patient closely and only starting antiviral treatment if evidence of flu develops. Read article

September 19 2009 ~ Is this another
instance of the virus travelling from humans into pigs?

The news that a pig farm in Northern Ireland has reported swine flu leads to this comment from a ProMed moderator:

"The pattern of this outbreak in the swine herd is exactly what we
would expect in a typical influenza incursion into a highly
susceptible, non-vaccinated swine herd. This picture of high
morbidity, very low mortality and low case fatality is not surprising.
Influenza in swine causes widespread disease but is of minor
importance because the pigs get sick and readily recover in most
cases. It is not as important a pathogen as those causing high
mortality disease.... Hopefully, thorough outbreak investigation will help
determine potential exposures of the pigs and whether this is another
instance of the virus travelling from humans, in a reverse fashion,
over the zoonotic bridge to infect swine."

It is useful to remember that the "zoonotic bridge" between humans and animals has two-way traffic.

September 11 2009 ~ "unsubstantiated speculation about the inevitability of a 2nd wave
of infection"

The ProMed moderator comments on the study published in the journal Nature Biotechnology that swine flu [influenza pandemic (H1N1) 2009 virus] can infect cells
deeper in the lungs than seasonal flu, making people who catch it
more likely to develop serious complications (reported in the Times) The moderator comments: " The authors of this paper have used carbohydrate microarrays to
demonstrate that influenza pandemic (H1N1) 2009 virus can attach to
cells deeper in the respiratory tract than seasonal (H1N1) viruses.
This suggests that the pandemic virus has the potential to cause more
serious complications, particularly if it undergoes progressive
mutation towards infection of lower respiratory tract cells. These
interesting findings employing novel technology are somewhat obscured
by unsubstantiated speculation about the inevitability of a 2nd wave
of infection and other unrelated matters." The Times report mentions that Professor Beddington defended the decision to treat large numbers of
the population with antiviral drugs (450 000 doses of the drug Tamiflu (oseltamivir) have
been distributed, 10 times the number of confirmed flu cases)

"... the official
Scientific Advisory Group for Emergencies (Sage) had been divided on
whether Tamiflu should be made universally available. Some members of
the group, which advises the Cabinet, had feared that providing
antivirals to everyone infected risked the virus developing
resistance, he said. But he (Prof Beddington) added that there was little evidence that
the virus had built up any resistance."

September 5 2009 ~
"Singapore is the 4th country detecting and reporting pandemic
influenza H1N1 virus in porcines, preceded by Canada, Argentina, and
Australia..."

ProMed moderator comment continues, "...The virus infected another animal species, turkeys, in
Chile. Similar but unidentified or unreported events involving the
same or additional species, may have occurred in other countries and
should be surveyed and recorded. In fact, according to a report of 3
Sep 2009, ongoing surveillance for respiratory diseases in Manitoba
swine herds, Canada, has detected the novel pandemic H1N1 influenza
virus in several herds, including sow barns, nursery barns, and feeder
barns in various locations in the province (see
http://www.pigprogress.net/news/h1n1-found-in-several-manitoba-herds-3364.html)
WHO Pandemic Report 64

Sept 4 2009 ~ "Swine flu death estimate lowered" says BBC

The BBC today reports that the number of new cases of swine flu have fallen again in the past week - (although there must be many that are not reported or confirmed) and that

"Predictions that 65,000 people could die from swine flu in the UK this winter are unlikely to be realised, latest figures suggest...Previous estimates, which included the 65,000 figure, were based on an assumption that the death rate could be as high as 0.35% but advisors have now agreed that it is more likely to be 0.1%.
Commenting on the reduced estimates, Sir Liam said the figures may be revised again once a vaccination programme is introduced.
"We want the NHS to plan for a worst case scenario."
He added: "We are very unlikely to see a peak before the second half of October, which is something we're pleased about because we're expecting to be able to use the vaccine during October."

Scientists at Leicester University are conducting a trial in humans on a swine flu vaccine developed by Novartis. They have reported that one dose might be enough to produce a good immune response. Read in full

September 1 2009 ~ "we are moving into an arena of global ethics.."

www.canada.com
"The Canadian government should donate any surplus swine flu vaccine to poorer countries, say ethicists and medical specialists who are warning that a "me-first" mentality among rich countries will doom efforts to combat the global pandemic.
They say Canada and other wealthy countries should follow the lead of GlaxoSmithKline Inc. and Sanofi-Aventis, two of the world's major vaccine manufacturers. In response to an appeal from the World Health Organization, those companies plan to donate at least of 150 million doses of H1N1 vaccine for distribution in the developing world.
"I'm trying to get people to understand we are moving into an arena of global ethics, and if we keep thinking borders don't matter in the way we do, ultimately we are going to hurt ourselves," said Francoise Baylis, a bioethics specialist at Dalhousie University in Halifax..."

September 1 2009 ~ World Health Organization hopes that every country is willing to share results of its clinical trials

"The vaccine for the A(H1N1) flu virus produced by Chinese pharmaceutical company Sinovac Monday ....hopeful to obtain a production license this week.
...Sinovac's A(H1N1) flu vaccine could safely be given to people aged from three to 60 years old in a single shot, 15 microgram dose, and was approved by the unanimous vote of 43 experts...clinical trials on the vaccine show immunogenicity factors reach international standards, and its adverse reactions were similar to those of split vaccines for seasonal flu...
..
Zhao Kai, the leader of the experts team and a member of the Chinese Academy of Engineering said if approved, the vaccine in mass production would be reserved by the State instead of going on general sale.
"The government will decide whether and how to distribute the vaccine, based on the flu's development," Zhao said.
The vaccine will be altered if the virus mutates...
Shu Yuelong, another member of the experts team, an official from the Chinese Center for Disease Control and Prevention (CDC), said a flu pandemic in the northern hemisphere was almost "inevitable" during the coming Autumn and Winter..."

The article added that many countries are racing to develop a vaccine, and the World Health Organization hopes that every country is willing to share results of its clinical trials.

September 1 2009 ~ "Please can you only play cards with the person next to you and not in large groups..."

... Two call centres have been closed after staff spent most of their time playing cards and board games.
One operator working in Farnborough said that in a typical eight-hour shift, during the four weeks he was there, he would handle on average just two five-minute calls.
.."

The half-jokey, half contemptuous tone is not very helpful - but it is hard to disagree with Mr Littlejohn's comment that "this government's knee-jerk reaction to any problem is to announce headline-grabbing gimmicks designed to give the impression that they have everything under control..." (Read article)

August 30 2009 ~ The spread to turkeys (Chile) Who should get priority for H1N1 vaccine?

Chile has no record of H5N1 infection - but the danger, feared even more now that H1N1 has been shown to be able to infect turkeys, is that a new virus formed from a combination of H1N1 and H5N1, might be able to infect
humans and spread from person to person. Since the surface proteins of such a novel virus will never have been
in contact with human immunology system, it will be difficult to fight it off.ProMed posts a report by Julio Garcia Moreno MD, MSc,
Head of the Biomedical Department
Instituto de Salud FAblica de Chile. Acknowledging that vaccine is the best tool to cut the transmission of
the virus among humans and therefore the chance of infecting birds, he suggests that some African and south
Asian countries where H5N1 is rife should have priority for whole population vaccination and laboratory surveillance should also be intensified. It is "a matter of justice", he suggests, that

"....vaccine that should be provided free of charge for the
majority of this (sic) countries,"

The ProMed report can be read here. Extract: "the H1N1 pandemic
2009 virus has rapidly established itself and is now the dominant influenza
strain in most parts of the world. The pandemic will persist in the coming
months as the virus continues to move through susceptible populations.
Close monitoring of viruses by a WHO network of laboratories shows that
viruses from all outbreaks remain virtually identical. Studies have
detected no signs that the virus has mutated to a more virulent or lethal form.
...." Read in full

August 28 2009 ~ "The continued profligate use of Tamiflu in the treatment of mild
infections may ultimately promote the expansion of Tamiflu-resistant
virus.." ProMed moderator

"..since resistance is conferred by mutation at a single site in
the neuraminidase gene. Fortunately, there is no evidence so far to
suggest that Tamiflu resistance is spreading widely.... - Mod.CP" (URL) ProMed has also recently reported confirmation of H1N1 in Canadian pigs ("the disease was very mild,
with pigs showing only slight signs of respiratory illness..") and, in Chile, H1N1 in turkeys

"...Overall,
this event should serve as a warning to agricultural and public
health sectors to prepare well for the fall [2009], as the current
pandemic influenza virus is active in its ability to spread across
species."

We are grateful to Mary Marshall for forwarding this link to a statement via the FAO which quotes the FAO's interim Chief Veterinary Officer, Juan Lubroth on the subject of the two Chilean turkey farms where H1N1 has been confirmed. There is no H5N1 in Chile at present, but Dr. Labroth says that the strain could "theoretically become more dangerous if it adds virulence by combining with H5N1".

August 26, 2009 ~ Emergency authorisation from the FDA approval for rapid H1N1 flu Testing on Portable Lab - for the military

We read at www.medpagetoday.com
that military doctors are now going to use a portable polymerase chain reaction (PCR) testing device to diagnose novel H1N1 flu infections in troops overseas. The FDA granted approval less than three months after testing of the H1N1 panel began.

"...
The device, called JBAIDS (Joint Biological Agent Identification and Diagnostic System), is a rugged, suitcase-sized instrument that can run PCR-based molecular diagnostic tests. It has been under development for several years by a consortium of military health research centers, the CDC, and academic medical laboratories....
The H1N1 flu testing on the device will use the PCR primers developed by the CDC for use in public health laboratories.
...
In early 2010, according to the office, military health officials will request FDA approval to use the JBAIDS device for diagnosing H5N1 avian flu."

August 24 2009 ~ Half of GPs said they believe swine flu is too mild to justify taking a vaccine

The Guardian this afternoon: "Several studies suggest up to 60% of GPs would oppose being immunised because they are concerned the safety trials will be rushed....in line with a much bigger survey of nurses published a week ago by Nursing Times, which found that a third of 1,500 nurses would refuse vaccination.
A Canadian study published today in the journal Emerging Health Threats suggests the public, too, will have reservations that must be overcome if a vaccination campaign is to be successful in the autumn or winter. ...The Department of Health played down the results..announced 14 new fast-tracked research projects into various aspects of swine flu, costing £2.25m...."

August 21 2009 ~ No Tamiflu for mild cases, says WHO

The World Health Organisation says healthy people who catch swine flu should not be given Tamiflu. The advice, published on the WHO website as briefing note 8, directly contradicts British policy on the issue.

"...Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. Healthy patients with uncomplicated illness need not be treated with antivirals."

There is also specific advice for children, pregnant women and anyone with ongoing medical conditions such as diabetes on the World health Organisation website.On Thursday 20th August, a letter from the microbiologist, Dr Colin Fink, was published by The Times under the heading Vaccine caution
Swine flu vaccine could be a recipe for disaster. Extract

"...Completion of adequate safety trials before winter now seem unlikely. The Chief Medical Officer, Sir Liam Donaldson, feels that giving the vaccine to pregnant women is essential because high temperature with flu may cause abortion.
These pronouncements seem to be muddled thinking and a recipe for disaster. The same may be said for the widespread distribution of the antivirals Relenza and Tamiflu. Nothing will more rapidly aid a resistant flu strain to be widespread this winter. In most cases so far, this influenza is characterised by its mild nature..."

(My own case of swine flu is responding well to bed rest, Nurofen and plenty of fluids.)

August 10 ~
Tamiflu and Relenza - ".. the findings review of seven research studies should prompt the Department of Health to reconsider its policy"

The Telegraph reports this afternoon that Dr Matthew Thompson, a GP and senior clinical scientist at Oxford University and Dr Carl Heneghan, a clinical lecturer at Oxford University, say the findings review of seven research studies should prompt the Department of Health to reconsider its policy.

"...on balance the medicine does more harm than good in otherwise healthy children, the authors said..... Dr Heneghan warned that prescribing the drugs so widely will encourage flu to become resistant to the medicine."

The "National Pandemic Flu Service" is handing out the drugs to anyone who reports having a flu-like illness and actually handed out 150,000 doses of Tamiflu in its first week.

Monday, 10 August 2009 ~
Independent Leading article: This abuse of Tamiflu is dangerous for all of us

The Independent's report, reveals that tens of thousands more people are likely to have received the antiviral drug Tamiflu than actually have swine flu. The leading article speaks of "the potential medical and social costs" of such hoarding

" ...Medical researchers have long warned of the danger that the mass prescription of antivirals could result in the swine flu virus becoming resistant... Health authorities in Denmark, Japan, Hong Kong and Canada have already reported cases of patients whose swine flu carried a mutation...
The National Pandemic Flu Service hotline...
There was always a danger that the hotline would be abused when it was set up. .. At the very least, the Government needs to inform the public of the dangers of taking Tamiflu pre-emptively. A public advertising campaign highlighting the side-effects (which include nausea, vomiting and insomnia) would be useful..."

Fascinating insight today from an NHS doctor's blog on the subject of the telephone "swine-line" and the over-the-phone diagnosis of H1N1 and prescription of Tamiflu and Ralenza. His tone, on the whole, is restrained - except when one of his patients reveals that the "illiterate, protocol-bound automata" at the end of the line have exhibited a particularly otiose interpretation of "government policy"

"When I come across "policy" like this, I reach for my revolver..."

As for the mass dishing out of anti-virals, his view is the sane one; that

"for the time being, it is mostly a mild, self-limiting illness which is best treated with fluids, rest, paracetamol or good old fashioned aspirin. We are told the "second wave" in the winter may be more serious. Who knows? I don't. The media, thank God, is getting bored, and moving on. The bankers' bonuses and Freddy Flintoff's ankles are much better copy."

August 6 2009 ~ WHO predicts one third of the world's population will be infected

According to Reuters, the World Health Organization reported 162,230 confirmed cases and 1,154 deaths in its latest update last week. "But flu experts said this probably reflected only a fraction of the true count as not every patient can be diagnosed with a lab test.
Experts expect the flu will pick up activity in the northern hemisphere's autumn and the WHO predicted one third of the world's population -- two billion people -- will eventually be infected.....Drug companies have started making vaccine against H1N1 swine flu. But the recommended population of 160 million people, including healthcare workers and pregnant women, cannot be fully immunized until December, experts estimate. Two doses are needed for full protection.."

We have been warned (see below) that the massive use of Tamiflu is ill-advised and that it could result in the mutation of the (A)H1N1 virus.
. Reports on ProMed show that there is now a Tamiflu-resistant mutation of the virus. Cases of
A(H1N1) that were resistant to the anti-viral medicine have now been
found in the United States, Canada, Denmark, Hong Kong and Japan. (See Simon Jenkins' plea for common sense; "Scaremongering officials are leading us to lose all sense of proportion and waste resources. People should take an aspirin..") The government ordered huge amounts of the drug when they thought H5N1 avian influenza was going to be the next big epidemic. When bird flu failed to materialise in the population the Tamiflu remained unused - and the clock was ticking towards the sell-by date. Tamiflu is now distributed to vitually anyone in the UK self-diagnosing swine flu - but if there is any evidence to show that antivirals have made any difference at all to the progress of these mild cases we have not seen it or heard about it.

August 3 2009 ~ 33 percent of A(H1N1) patients "asymptomatic"?

A comment on ProMed today from Dr. Steve Berger of the Tel Aviv Medical Center
says that if so many of those infected with swine flu show no symptoms, then

"much of
the current approach to reporting and containment will have to be revised.
Screening in airports, emergency rooms, etc., begins with the
assumption of a febrile patient. Infection without overt signs will
be neither reported nor restricted, and could presumably promote
spread of the virus to others..."

He also suggests that present assessments of case/fatality rate could be skewed by this. The same ProMed posting reports that in Hong Kong and Taiwan influenza A virus subtype
H3N2 is present as a new influenza threat. Thomas Tsang, controller of Hong Kong's Center for Health
Protection (CHP) is quoted "However, it has some genetic changes
distinguishing it from the old Brisbane strain" adding that overseas
health authorities, including those in Canada, Britain and Australia,
had also found the new variant.
According to the CHP, H3N2 accounts for 43 percent of flu viruses
circulating in Hong Kong, while A/H1N1 accounts for 49 percent.

July 23 2009 ~ Swine flu's oink worse than its bite

The hype and frenzy continues, fanned easily by various factions. (On Channel 4 last night, the highly regarded British epidemiologist,Tom Jefferson, said that the vested interests to turn it into some kind of killer threat include pharmaceutical companies, governments, and the media, together with certain quarters of the scientific community)
Meanwhile, Dr. Richard Schabas, who was Ontario's Chief Medical Officer of Health from 1987-97 ends his drily critical look at what he considers "such a pandemic dud" like this: "...The media love this story and accept the pundits' gloomy predictions uncritically. If this turns out to be the fourth pandemic false alarm in six years, as I think it will, it will be time to start asking some probing questions." (read article in the Ontario Star) It will be ironic if the strain of (A)H1N1 mutates as a result of the massive use of Tamiflu - as the warning below suggests it may well do.

July 27 2009 ~ Professor Roy Anderson's "clear conflict of interest"

The NHS signed contracts earlier this year with pharmaceutical companies Roche, which makes Tamiflu, and GlaxoSmithKline, which makes Relenza, bringing the UK's total capacity to 33.5 million treatment courses. Concerns about links between advisory committees, pharmaceutical companies and research grants have been voiced for many years now (According to the Guardian in September 2001, it was Nestlé not the NFU, that persuaded Tony Blair to halt the already advanced foot and mouth vaccination preparations.) As for advisory committees, it was in 2003, that Michael Meacher told The Observer:

".. I constantly argued that nobody with significant commercial links should be allowed to sit on these bodies. It is vital they are truly independent."

Professor Roy Anderson's links with industry are well known - and we learn from today's Mail that the egregious Professor has been asked to step down from "SAGE", the Scientific Advisory Group for Emergencies, because of his financial association with GlaxoSmithKline. In May, he was interviewed on the Today programme and called for the distribution of anti flu drugs "we have two effective anti-viral drugs.." - but there was no mention of the fact that he receives annual payments from GlaxoSmithKline. He earned £116,000 at GSK last year.
The danger of the overuse of antivirals - as we were warned below - is that it actually can bring about a drug resistant strain of the virus - and a far more serious situation than the present one.

July 23 2009 ~ "Most confirm that the one thing not to take is Tamiflu"

Common sense - a rare commodity - from Simon Jenkins who wrote in the Guardian yesterday:

"Just two months of swine flu sniffles, and madness reigns
Scaremongering officials are leading us to lose all sense of proportion and waste resources. People should take an aspirin..Untold billions are still being spent on "the risk of terrorism". Who knows what disproportionate costs have been incurred in what is an almost annual flu scare.
London's accident and emergency services are desperate at the best of times. I have lost three acquaintances to avoidable hospital-induced infection in the past year. Last week a friend had to wait seven hours after a bicycle accident to have a shattered arm set, by when a simple wound had become complex. In despair he went private.
These same resources are now being diverted to "await" a flu epidemic. The government is recruiting 2,000 telephone advisers to answer inquiries from members of the public reduced by the public health apparat to nervous wrecks. This will inevitably suck resources from elsewhere in the health service.
I would like to know how many people will die of heart attacks, meningitis, MRSA and delayed cancer treatment while health politicians play Whitehall games with flu..."

July 20 2009 ~ Seasonal flu results in an estimated 40,000 to 200,000 deaths each year in the EU...

.. But the big news remains "Swine Flu" about which EU health commissioner, Androulla Vassiliou, has warned today that "there won't be vaccinations for everyone."
She has pointed out that the number of people across the EU most at risk from the new flu, more properly termed "A(H1N1)", had been estimated at 60 million by "Brussels experts". The website euobserver.com notes that if the virus mutates into something less mild, there could be

"...a fight between member states for vaccines. Germany, France and the UK have already ordered billions of euros worth of vaccine stockpiles...The European Commission has been pushing member states to cooperate and pool resources so that (the) least prepared member states are also covered.
This is meeting resistance in countries such as Britain, which considers itself well prepared...."

And the use of what Alan Johnson called "stacks of antivirals to cover not just 50% of the population but above that" - i.e. Tamiflu - could well, we are told, create a resistant strain before too long. So, we are seeing a plea for vaccine supplies to be shared out fairly and concern for the underdog expressed from Brussels. (How differently the EU behaves when it is a case of exportable animals, their welfare and health. A request was made recently for the EU Commission to establish a bank to store at least seed stock of different bluetongue serotypes so that in case of an outbreak of Bluetongue, vaccine could be produced quickly. The request was declined.)

July 19 2009 ~ "giving out all this Tamiflu is a recipe for disaster..."

Stories about Swine Flu continue apace with the bizarre advice in the papers today that. as Andrew Marr put it, "women who want babies should perhaps put that off, that young women with young children are under great threat"
He was interviewing Alan Johnson who told him "We've got stacks of antivirals to cover not just 50% of the population but above that...." - even though he had just told Andrew Marr that "in general, the vast majority of cases, it's a mild illness.." The problem with "the stacks of anti-virals" referred to by the Home Secretary is - as one British microbiologist told us - is that their use will create a resistant strain before too long:

"..giving out all this Tamiflu is a recipe for disaster.It should be only for the medically vulnerable. I do not believe that it has saved any lives with the virus relatively benign at present, but it has introduced an immediate selection pressure for a resistant strain to emerge."

Monday July 13 2009 ~ The blessings of vaccination

The first doses of A/H1N1 vaccine are set to arrive in Britain in September. Regulatory approval, we find, can be rushed through in less than a week.
All this is in order "to build a nationwide immunity to the disease, the biggest vaccination program of the past 50 years" - against a disease whose mildness is its most noticed trait.
The lead negotiator on A/H1N1 of the British Medical Association, Peter Holden, told the Sunday Times that if the virus does mutate, the idea is to give people immunity, but he also admitted that the sheer logistics of dealing with 60 million people can't be underestimated.In contrast, the logistics of dealing with several million farm animals are considerably more straightforward. Vaccines for the economically disastrous foot and mouth disease have been fully effective for a decade and are getting even better, while the technology for rapid diagnosis is being used most successfully elsewhere. Illogically, there seem to be no suggestions in this year's draft "Exotic Disease" Contingency Plan to give the blessings of modern technology any higher profile than in 2001 or 2007. Apart from a few changes of terminology, this year's plan looks at present like a cut and paste version of those of previous years. DEFRA's consultation will, one hopes, receive pleas to simplify its impenetrable length and wording. Consultees might urgently question the underlying anti-vaccination (pro-protectionism) mindset of the EU that underlies DEFRA's own stance. Such discrimination against vaccination has no basis in veterinary science. Foot and Mouth, in particular, is a disease that brings the country to a halt and causes untold misery and fear.

WHO, OIE and FAO now agree that the flu should now properly be known as "pandemic
(H1N1) 2009" WHO update 58 from yesterday can be seen here. It records that the total of lab confirmed cases yesterday stood officially at 94,512. The WHO official total for the UK yesterday was 7447 - 3 of whom have died.

June 24 2009 ~ A/H1N1 flu cases about 3,000 now in the UK

The BBC says today that the number of confirmed cases in the UK is 2,944, including 686 in Scotland. The virus is spreading from person to person in most countries. The last time we mentioned it, on June 5, the number of H1N1 flu cases worldwide reached 19,273. According to the WHO it was 52,160 on June 22.

Friday June 5 2009 ~ H1N1 cases in the UK has reached 404

313 in England, 88 in Scotland, two in Northern Ireland and one in Wales. The Independent reports "The virus is spreading from person to person in countries as far apart as Britain, Spain, Japan, Chile and Australia. The number of swine flu cases worldwide has reached 19,273, according to the latest WHO figures."

Wednesday, 3 June 2009 ~ A/H1N1 - Healthy Scot is now critically ill

Many will be wondering if this is a worrying development. The Independent:
"A 45-year-old man has become the first in the UK to be made critically ill solely because of swine flu, health officials said yesterday.
...in intensive care at the Royal Alexandra Hospital in Renfrewshire last night...
Scottish Health Secretary Nicola Sturgeon said "....in any flu scenario, small numbers of patients will develop complications and will require that kind of medical intervention." The total number of cases in the UK is still only between 300 and 400 - but according to the Telegraph, last night 61 new cases of H1N1 swine flu were confirmed in Britain bringing the total number of people who have been sick with the virus to 339.

May 27 2009 ~ A triumph of hope by the Department of Health over any sensible evidence?

The statement made by the Dept of Health almost every day since the 15th May, would seem to be claiming the credit for containing the spread of A/H1N1 in Britain.Quoted by the BBC yesterday:

"A Department of Health spokesman said: 'The localised cases of swine flu found in the UK have so far been mild, and our strategy of containing the spread with anti-virals appears to have been effective in reducing symptoms and preventing further spread of infection'...."

One does wonder on what scientific basis they can make this statement. What evidence have they got that in these cases - which have been clinically mild - antivirals have made any difference?
Seasonal influenza wains as the weather warms - without intervention from the Department of Health. The British population has not met this particular H1N1 before and the small clusters we are seeing now are just the sort of local outbreaks of respiratory infection often seen in institutions from time to time - and not usually diagnosed so intensively. There is no evidence whatsoever in this outbreak that the strategy of the DOH has "contained" the course of disease in individuals nor its spread onwards. The repetition of self congratulation in the press releases surely inspires less confidence in the Department - not more.

May 25 2009 ~ "This is going to be a marathon rather than a sprint..."

H1N1 is spreading faster than official figures suggest. Only about one in 20 cases is being officially reported in the U.S, according to the Centers for Disease Control and Prevention, while the virus may be 300 times more widespread than health authorities have said, according to John Oxford in yesterday's (Independent)
The figures of confirmed cases are giving the wrong impression of the spread of the disease since the symptoms are often so mild that "while the authorities were not hiding cases, they were not hunting very hard for H1N1.." This morning, Bloomberg quotes Australia's chief medical officer, Jim Bishop, after the 17th confirmed case in Australia and with test results are pending on 41 others: "I think we will see the number rise. This is going to be a marathon rather than a sprint."An emailer yesterday, after noting John Oxford's words that surveillance was not really happening,
commented: "Surprise, surprise! Sounds all too familiar" (The paragraph above was not intended in any way to dramatise the global situation. As has been gently pointed out to us in the past weeks, the spread of a typed H1N1 is not really any more significant than any other 'flu of low pathogenicity spreading - without particular surveillance each year. Nor is the risk of a return with a vengeance in the Autumn any worse than for any new strain of flu.)

May 23 2009 ~ WHO flu update 36..

Last updated world total from the World Health Organisation (update 36) was 11,168 with the UK total at 112 and Spain 113. In Chile and other countries in the Southern Hemisphere, cases are more worrying since, as Margaret Chan has said, H1N1 in Southern Hemisphere could mix with ordinary flu and mutate in "unpredictable ways" (Reuters)UPDATE WHO update 37 (Sunday) puts UK total at 117 - but we note that John Oxford has said it's actually nearer 30,000 - at present symptoms may be so mild that those infected don't even notice. (Independent) "the figure, put out by the HPA, is increasingly coming to be seen as unrealistic..."

ProMed quotes Professor Osterhaus (Head of Virology at the Erasumus Medical
Centre in Rotterdam) in this posting of a forum thread at flutrackers (here). Speaking at
at Europe's largest conference on infectious diseases in Helsinki ( European Society of Clinical Microbiology, Infectious Diseases) he said that

the outbreak of influenza A (H1N1) is without question one of
the most important events of the past 40 years in human influenza.

And he stressed that the current H1N1 threat is a serious one.
He outlined the "3
cornerstones of medical preparedness in the face of swine-origin flu:
Good surveillance and diagnostics; effective treatment/antiviral
therapy; and vaccination, the foundation of prevention".
(WHO report 34 shows the global H1N1 flu total at 10,243, with 102 in the UK )

May 16 2009 ~ A/H1N1 quietly rumbles on.

In spite of the widespread feeling that it has turned into a damp squib, new flu cases increased by over a thousand during the past 24 hours (source). In the USA, Wyoming, Alaska and West Virginia are the only states not to have reported cases of H1N1 flu. At least one expert in the UK predicts that we
will have a world pandemic as a result of spread in the Americas. The banning of pork in some quarters does seem an extraordinary move however when no one at all seriously thinks that uninfected meat can cause disease (As we said yesterday, DEFRA oddly allows all suspected bTB culled cattle into the food chain). Should not attention be centred on getting birds vaccinated against H5N1 and tracking down foci of
infection? There is far more waste of life - including that of children - as a result of H5N1 (even though a new study is now suggesting that the 'human nose is too cold for bird flu...'

May 14 2009 ~ Could the development of A/H1N1 have been 'human error'?

As we said yesterday on Twitter, the World Health Organsation has been told by a researcher and virus expert, who had collaborated on research that led to the development of Tamiflu, that the swine flu virus may have been created as a result of human error. The Australian concerned, Adrian Gibbs, intends to publish a report suggesting the new strain may have accidentally evolved in eggs used to grow viruses and from which vaccines are then made. He had found the rate of genetic mutation in the new virus to be about three times faster than that of the most closely related swine viruses, suggesting it may not have evolved in pigs.
The World Health Organization is reviewing his study The FAO and OIE will also be looking into the question. Mr Gibbs said he aimed to submit his three-page paper to a medical journal.
However, Nancy Cox, director of the CDC influenza division is quoted on Bloomberg ".. contrary to what the author has found, when we do the comparisons that are most relevant, there is no evidence that this virus was derived by passage in eggs." ( The Bloomberg article gives more detail)

May 13 2009 ~ Three Additional Cases of Influenza A (H1N1) Confirmed. UK Total Case Count Rises to 68

And we hear that the CDC's PCR diagnostic rapid test kit to detect H1N1 has now been not only been distributed to all states in the U.S. (see below) and the District of Columbia and Puerto Rico but are also being shipped internationally as well. "This, combined with ongoing monitoring through Flu View should provide a fuller picture of the burden of disease in the United States over time" says the CDC.

May 11 2009 ~ Rapid RT-PCR test kits now being used all across America to differentiate flu virus strain

In America, confirmed cases of H1N1 flu, although mild, are nevertheless multiplying. (WHO update 24 puts US cases at 2254 but has still not updated UK figures.) RT-PCR kits, determining what kind of virus the patient has within two to three hours, are now being used in all 50 states - ironically, without the official approval that has caused such delay in the field of animal health. Bloomberg reported last week that : "Laboratories.... are receiving test kits from the CDC to look for the markers of swine flu." An email from the US asks warmwell: "They're not waiting for official approval before using the kits here. What's happening in the UK?"Does anyone know? Informed comment gratefully received by email.More on rapid diagnostic kitsBBC today "...the Health Protection Agency stressed that because of the time taken to diagnose swine flu, all 10 newly-confirmed patients may already have recovered and be symptom-free."

Monday May 11 2009 ~ Producing flu vaccine: "There's a reason why not a lot of (companies) want to do this.."

An Indiana Star article explains how reluctant vaccine manufacturers are to make flu vaccine: there are no big financial opportunities in it.

"... it's hard to predict how many people will get flu shots because nobody knows each year how bad a flu season will be... governments would have to guarantee the vaccine would be bought... it couldn't be done until the new version gets safety testing.."

The map can be seen here: www.who.int (although it fails to note that the total in the UK has now risen to 48.) www.ajc.com reports:

"... swine flu has extended its spread in the Southern hemisphere, where flu season is just beginning. Argentina and Brazil have now confirmed their first cases of swine flu, joining Colombia as South American nations reporting infections.."

The fact that there are confirmed cases in the Southern hemisphere seems potentially serious.

May 10 2009 ~ Vaccine meeting on May 14

Whether the virus fizzles out at the end of the Northern Hemisphere's flu season or, spreading in the Southern Hemisphere then comes back north in a nastier form, depends in part - according to Anne Schuchat, interim deputy director for science and public health of the U.S. Centers for Disease Control and Prevention - "on whether its traits hold steady, mutate, or mingle with the deadly H5N1 bird flu circulating in Asia", reports Bloomberg (free registration needed to retrieve article) , adding that a WHO panel will meet on May 14 "to decide whether drugmakers should begin producing hundreds of millions of doses of a vaccine against the new illness."

10 May 2009 ~ "Perhaps our Government would have done better to send a leaflet to itself".

Comment from Christopher Booker in the Sunday Telegraph on the government's swine flu advice. (I thought their TV advert was understated and dramatic with its use of colour and monochrome - until I realised the sound was off. Then, for me at least, the insistent voice-over quite spoiled the effect.) The Sunday Telegraph article begins, however, with a summary of what Marta Andreasen faced when she was appointed to sort out the EU's accounts. Her book on EU, Brussels Laid Bare is published tomorrow. It concerns her attempts to put things right - and the subsequent and increasing hostility and threats: "...her life descended into a five-year nightmare, as she faced one tribunal or court after another, all finding her wholly to blame," writes Christopher Booker.)

Sunday 10 May 2009 ~ "best course of action for the welfare of the herd" was to kill 500 of them

The huge pig farm in central Alberta where pigs were found to be infected with the new swine flu virus was the scene of a mass killing of pigs on Friday - not because of the virus, but because "the pens had reached maximum capacity". This will recall the so-called "welfare culls" of the dark days of Foot and Mouth 2001 when animals were in such distress from lack of food or overcrowding that it seemed "kinder" to kill them. Until animals are kept in conditions where they can live without distress in return for the animal 'products' we take, there will be health and stress problems that can easily rebound on human beings. ( Circumstantial evidence is the only proof that the carpenter at present being blamed actually did infect the Alberta pigherd. Source)

In the United States cases continue to increase - today 1,639: Yesterday's total in the US was 896. WHO's update 23 reports cases in the UK as 34 - but health officials have confirmed eight new cases of swine flu today (BBC), bringing the UK national total to 47. Twenty nine countries have officially reported 3440 cases of the influenza.

May 8 2009 ~ "the converging crises of the 21st Century"

On Wednesday 6 May, the All Party Parliamentary Group on Peak Oil and Gas met to consider
"How should we respond to the converging crises of the 21st Century?" The speaker was Prof. Thomas Homer-Dixon (author of 'The Upside of Down' and 'The Ingenuity Gap') - and there are now some very interesting sound or powerpoint files that can be downloaded from the www.appgopo.org.uk website by interested members of the public. "Resilience" is certainly becoming an important concept.

Friday May 8 2009 ~ H1N1 "still serious gaps in the knowledge
about the virus"

Following some confusion about whether pork is safe to eat , an updated joint statement from the FAO, OIE, and World Health Organization intending to reassure the public about pork has been quoted on ProMed. Extract:

"....
Influenza viruses are not known to be transmissible to people through
eating processed pork or other food products derived from pigs...
Pork and pork products, handled in accordance with good hygienic
practices recommended by the WHO, Codex Alimentarius Commission, and
the OIE, will not be a source of infection..."

The moderator (AS) sounds a note of caution:
"... Since there are still serious gaps in the knowledge
about the virus, its epidemiology and pathogenicity, communicating
clear, unanimously accepted and scientifically-based information and
advice to the public is complex..." The posting is best read in fullThe WHO's update 20 reports that

"...24 countries have officially reported 2371 cases ..
Mexico has reported 1112 laboratory confirmed human cases of infection, including 42 deaths. The United States has reported 896 laboratory confirmed human cases, including two deaths. the United Kingdom (32)..."

May 7 2009 ~ H1N1: 28 confirmed cases in England and four in Scotland.

"... A further 390 suspected cases of the H1N1 virus are being investigated. Across the globe, more than 1,658 cases have been confirmed and 44 people have died - 42 in Mexico and two in the US.
In America, the Centres for Disease Control and Prevention increased the number of confirmed cases from 403 to 642, including the two deaths."

The World Health Organisation says at least two injections will be needed to protect against both the seasonal form of flu and the H1N1 strain and will ask drug companies to start producing swine flu vaccine once they finish making seasonal flu jabs.Meanwhile, ProMed calls the WAHID report on the affected pigs inthe Alberta farm

"....an absolutely fascinating report as it clearly indicates how
the proverbial zoonotic bridge is a 2-lane highway. Humans and
animals can interface and transmit disease through many varied and
unpredictable scenarios...."

May 6 2009 ~ Flu origin? What is of more importance is any gene changes which increase virulence.

Marie Gramer, who runs a reference collection of swine flu viruses at the University of Minnesota in St Paul, was quoted in the New Scientist yesterday.

"...While triple reassortants are common in North American swine, the novel H1N1 may well have first appeared in pigs elsewhere - Mexico seems an obvious possibility, as the known first human cases emerged in there. Given international movements of both pigs and people, the virus could have emerged wherever the North American reassortants have travelled. It might even have first arisen in people.
There is also a chance that it first arose on a US pig farm, but was never sent for analysis because it caused only mild disease. "I don't think it's possible to say,"..."

What is vitally important - and now possible, thanks to modern advances - is to keep an eye on what happens to the virus genetically. That will allow the real experts to track, as (or if) they emerge, any genetic factors which could increase virulence, turning this "mild" flu into something much more to be feared.

May 6 2009 ~ "One World, One Health" said the OIE in January....but global sickness looks ever more likely

"The new concept, "One World, One Health", has recently appeared, indicating that the world has suddenly woken up to the link between animal diseases and public health. And about time too! .......We can only hope that the discussions currently taking place on the concept "One World, One Health" will eventually lead all countries to give a firm commitment to making their animal health situation transparent and setting up mechanisms for the early detection of disease outbreaks..."

It is alarming to see a new strain of Foot and Mouth disease in Iraq that may well be impervious to present vaccines ( Thanks to the FMD news service of the University of California, Davis, for this worrying link) UPDATE Ruth Watkins writes that "there are one or two new FMD serotypes emerging possibly from India and Pakistan, with multiple infections and carriage of FMD in buffalo and other bovines, from complex recombinations and rearrangements of the FMD RNA genome and these have been emerging in Iraq and Iran. It is not surprising that such events take place, and not particularly onerous to make a new vaccine to a new serotype if required using the tried and tested methods."

May 5 2009 ~ H1N1 in Southern Hemisphere countries: " We are in a critical phase."

Julian Tang, consultant with the Division of Microbiology at National University Hospital in Singapore, is quoted today by Reuters. He explains that although so far: "we have not seen any particular virulence with this virus, it can be a candidate for reassortment with other potentially more virulent strains of influenza, such as avian H5N1." The new H1N1 flu virus is expected to surge in the southern hemisphere when the winter season begins. Bill Rawlinson, head of virology at the Prince of Wales Hospital in Sydney is quoted:

" It does appear mild but every year in Australia, we have 1,500 to 3,000 deaths due to flu. When you get a new strain...you do see an excess of deaths due to new strains because people don't have immunity."

Raina MacIntyre, professor of infectious diseases epidemiology at the University of New South Wales, is also quoted as saying, "We are definitely more at risk given we are coming into our winter, when influenza transmission is intensified ... we are in a critical phase right now."
Read full article Another interesting article today is Reuters' ( "What happens if swine flu goes away?")

May 5 2009 ~ OIE comments on the findings of "A/H1N1" in pigs in Canada

"... The Canadian Veterinary Services decided immediately to put the farm under quarantine. The sampled pigs tested positive to the"A/H1N1 virus". It was a mild disease and the pigs have now recovered... the OIE is waiting for the results of scientific experiments aimed to determine the susceptibility of different animal species vs the "A/H1N1" isolated in infected humans..." Read in full

".... Are we really so addicted to eating meat (even as we demand that meat be inexpensive, meat processors want to make more money, which means faster, meaner ways of raising and slaughtering animals for food) that we're willing to risk the millions who could die from such mutating viruses? Has our desire for gustatory pleasure at any cost pushed us into terrible consequences as we creep toward an ugly future? The "big one" may not be this particular version of the flu, but scientists say we have not seen the last of H1N1; not by a long shot. ...No one is glad for the swine flu or the economic meltdown, but maybe these great calamities are the push we needed to re-boot and start afresh.
We are a world out of balance, to be sure.
.."

See Promed for updates. (In Toronto a youngster who came down with the H1N1 virus in Alberta has now become severely ill. It's the first time since the outbreak came to Canada that anyone has experienced anything but mild symptoms, and there is no evidence that the child has been to Mexico. Source)

May 4 2009 ~ "... nine meals from anarchy"

As media interest in H1N1 slowly recedes, a letter in the
Irish Times reminds us of the risks of a global pandemic really happening:

"... we have become blind to the risks of a systemic failure...
...there is probably not more than three days' food supply available in-system, a result of our super-efficient, just-in-time delivery models.... .. as urban populations rise, industrialised agriculture expands, and growing pressure is placed upon our eco-system..."

The writer concludes that the "peak and decline in global oil production" makes the risk of a supply chain collapse even more likely and urges everyone, as a matter of urgency, to "reassess our vulnerabilities and how we manage risk". (See also warmwell pages on food security and the Transition Towns initiative.)

Monday May 4 2009 ~ WHO latest update on H1N1

Bearing in mind the view that we may, after all, be going to see a pandemic as a result of the flu reaching poorer Southern Hemisphere countries such as Costa Rica and Columbia (See WHO update 13)- just beginning their flu season - we note the WHO latest case count (updated):

The head of the World Health Organisation has hit back at critics who have accused the WHO of an over-reaction to the flu crisis, warning that it may return "with a vengeance" in the months ahead. She told the Financial Times that the end of the flu season in the northern hemisphere meant an initial outbreak could be milder but then a second wave more lethal - as happened in 1918. See FTCosta Rica and Columbia however are now entering their flu period and cases there have been confirmed today. This bodes ill for the liklihood of a pandemic.

May 3 2009 ~ A Mexican worker may have infected Canadian pigs with H1N1 - an "important new development" says ProMed

"...Canada has announced that a herd of pigs has tested positive for swine flu.
A senior agriculture official told a news conference that the pigs may have been infected by a farm worker who fell ill after returning from Mexico last month."

.. is repeated by the Chinese news agency news.xinhuanet.com which reports that this has been the first time that the new H1N1 flu virus has been found in pigs. They are from a farm in the western province of Alberta: "Genetic testing shows the pigs in Alberta were infected with the same virus responsible for cases in Mexico and other countries around the world."UPDATEProMed also covers this report. We read from the quoted article that all the pigs are recovering or have recovered and that "The chance that these pigs could transfer virus to a person is
remote." The moderator, however, says that this "important new
development poses "several key important questions which ProMED-mail hopes will
be answered shortly...As always, with the influenza virus, answers to these questions will
inevitably generate new questions but the sooner we get some of the
basic facts out, the better we can understand this important new development."

May 3 2009 ~"... flies were recognised as causal factor in the respiratory disease that was affecting the locals at that time"

We are told that some time ago many swarms of flies invaded La Gloria from the waste manure lagoons next to the industrial pig units. Health officials had to come and spray on a big scale as the flies were recognised as causal factor in the respiratory disease that was affecting the locals at that time. An emailer sends links including one to a paper by an international team of scientists - including Jay Graham and Ellen Silbergeld of Johns Hopkins - published in the May-June 2008 Public Health Reports.pointing to a concrete example of flies acting as a flu
vector.

May 3 2009 ~ Sows at La Gloria live with their piglets in cages so small that they have room to lie down but not turn around

The Mail on Sunday quotes Dr Michael Greger, director of public health and agriculture at the US Humane Society

"There is evidence that flies landing on animal waste can spread the flu virus for miles around.
Pig waste lagoons are a great danger to human health. There are many ways - the wind for example - that illness can be spread from them. In the case of this current swine flu, the virus could easily escape from factory farm facilities.
Sows at weaning farms such as Site 8-2 live with their piglets in cages so small that they have room to lie down but not turn around, a company spokesman said.
They stand on grates over a water-filled pit. Once a week, the urine and manure is flushed into the lagoon, which has a clay lining that the company says prevents any seepage."

Saturday May 2 2009 ~ "It isn't the pig factory smells... but commercial units with hundreds and thousands of pigs are sufficiently large to provide the "immune driven mutation.." writes Dr Ruth Watkins

"A molecular test for RNA, such as Dr Breeze's test, would be the best way of finding what you do not know might be there, Especially in a virus as variable as influenza. The new H1N1 2009 human virus must have been in swine somewhere, it would seem from the sequencing and analysis of the genetic data that it is there somewhere.."

She writes that the commercial units with hundreds and thousands of pigs are sufficiently large to provide the "immune driven mutation" since the newly reassorted virus has to compete with the original swine virus and then exit the pig in sufficient quantity to be infectious, be competent to infect a new host, and to compete with other prevalent influenza viruses. Even so, she suggests that the likely outcome is that the virus then fizzles out. (Read in full link mended- apologies) As for the confusion about the origin of the virus and whether it really is a triple reassortant, Andrew Rambaut's work suggests strongly that although this is now "a human flu in that it is spreading from person to person .. it is clear from the analyses here and elsewhere that it has its immediate origins in swine flu."

May 2 2009 ~ H1N1 From ProMed summary of the current situation

ProMed "... as of 1 May
2009 there have been a total of 367 cases and 10
deaths due to influenza A (H1N1) infection
officially confirmed coming from 13 countries, up
from 257 confirmed cases and 9 deaths from 11
countries yesterday (30 Apr 2009). ....
According to newswires, France and South Korea
have confirmed cases, all with history of travel
to Mexico. Countries with contact cases (those
without a history of travel to a known "infected"
country, and known contact with other H1N1 cases)
include the USA, Canada, the United Kingdom
(Scotland), and Germany."

May 1 2009 ~ Private Eye sums it up....

The front cover reminds us that there are worse things than swine flu...

May 1 2009 ~ "The Department of Defense can fast track a reagent
within hours for use in hand held satellite linked PCR device..."

On the subject of the inability of states to conduct on site testing for pandemic H1N1, Stephen M. Apatow,
Founder, Director of Research and Development
Pathobiologics International, has written a memo mentioning
the rapid diagnostic kit by which the Department of Defense can fast track a reagent
within hours.

"This
molecular diagnostics technology has existed for years but has not yet
reached the grassroots physician/veterinarian level."

Without validated tests, he says, there is a wait of
2-3 days because samples need to be shipped to the CDC lab in Atlanta. He calls this "a public health infrastructure disgrace"
He recalls in the midst of a previous WHO pandemic level 5 scenario,

May 1 2009 ~ Rapid diagnostic test: "this identifies the current H1 and future changes in that target that have not yet evolved"

Meanwhile, Dr Breeze has given warmwell.com permission to quote from a letter whose subject concerns the ability of the TessArray® RPM-Flu assay to detect the current H1N1 flu accurately and fast. Dr Breeze comments:

"This technology provides the actual sequence of up to 1500 bases of the nucelic acid target so if the H1 target mutates this test tells you the mutation directly. It is biosafety level 2 and does not require Biosafety level 3 containment because no virus is grown."

Extracts from the letter The language is highly technical - but we read that TessArae makes the following offer to recipients of the letter:

"If you want to analyze clinical specimens with suspected 2009 outbreak swine flu, we are available to support your use of the TessArray RPM-Flu 3.1 assay. If you are willing and able to share your assay results with the community, then we are willing to replace a few of your TessArray RPM-Flu 3.1 assay kits at no charge."

The key point - as Roger Breeze makes clear- is that this rapid diagnosis kit "identifies the current H1 and future changes in that target that have not yet evolved."

May 1 2009 ~ "If you want to get money out of government, go and ask government for money for your research," says Simon Jenkins

Simon Jenkins (his article in yesterday's Guardian expresses frustration at how irresponsible it is of scientists as well as journalists to hype the flu scare) was in adversarial conversation with the Professor of Virology at Barts, John Oxford, on the Today Programme. Listen again to the interview John Oxford defends the way scientists turn to the media by using BSE/CJD as an example of where there should have been more hype: "I told my children not to eat beef...". An unfortunate choice... " An industry was almost destroyed!" said Simon Jenkins, reminding him that "We're still paying the price of that scare in the closure of abattoirs everywhere." Why are the scientists not screaming about the 1000 people who die every week from MRSA and C difficile he asks, and the thousand children a day dying of malaria? Listening to the replies to this one feels it was just as well they were speaking from different rooms. The thrust of Simon Jenkins' argument is that "scaring the public as a way of getting money out of the government is irresponsible". Listen Again

May 1 2009 ~ "Factory farms are not biosecure at all."

Johann Hari in the Independent quotes Dr Ellen Silbergeld, Professor of Environmental Health Sciences at Johns Hopkins University: "People are going in and out all the time. If you stand a few miles down-wind from a factory farm, you can pick up the pathogens easily. And manure from these farms isn't always disposed of.."He concludes

"Of course, agribusinesses is desperate to deny all this is happening: their bottom line depends on keeping this model on its shaky trotters. But once you factor in the cost of all these diseases and pandemics, cheap meat suddenly looks like an illusion. ... we need to shut down these virus factories - before they shut down even more human lives."

May 1 2009 ~ " it is unclear whether or not anybody has actually tested the pigs and workers at Granjas Carroll"

Blogs are calling upon mainstream media for responsible investigation into the potential role of CAFOs (Confined Animal Feeding Operations) We read on www.cjr.org

"Major news outlets have tentatively begun to do just that over the last two days...La Gloria is located close to a million-pig farm, Granjas Carroll, which is partly owned by Smithfield ...
So far, however, there is no evidence of a direct connection between the farm and the swine flu virus. But there are reasons to both suspect and doubt that such a connection exists... so far, authorities have yet to find an infected pig in Mexico, let alone at the Granjas Carroll farm. None of the pig farm's workers appears to be sick, either..... it is unclear whether or not anybody has actually tested the pigs and workers at Granjas Carroll...Clearly, it is too early to make bold pronouncements about CAFOs' role in abetting the epidemic ...." (read in full)

One warmwell reader who, like so many others, feels "Agriculture should be in the hands of humans and not corporations",
has read the Smithfield release, makes a wry comment and directs us to a sobering and well written piece by Elissa Altman in the Huffington Post.

May 1 2009 ~ "The situation continues to evolve rapidly," says WHO - but advises no restriction of regular travel or closure of borders.

"As of 17:00 GMT, 30 Apr
2009, 11 countries have officially reported 257 cases of influenza A
(H1N1) infection.
The United States Government has reported 109 laboratory confirmed
human cases, including one death. Mexico has reported 97 confirmed
human cases of infection, including 7 deaths.
The following countries have reported laboratory confirmed cases with
no deaths: Austria (1), Canada (19), Germany (3), Israel (2),
Netherlands (1), New Zealand (3), Spain (13), Switzerland (1) and the
United Kingdom (8)...." See ProMed for latest postings

is expected to be confirmed today, after the number of confirmed cases in the UK rose to eight. See Sky News which quotes Dr Alan McNally, senior lecturer and influenza diagnostics researcher at Nottingham Trent University. He said human-to-human transmission within the UK would not be a significant development.
"... We know that it is transmitted from human to human, it has happened in other parts of the world and we know it will happen here. I know that there will be interest in it because members of the public will see that they don't need to have been to Mexico to get it."

April 29 2009 ~ The UN says Egypt's plan to cull pigs is a mistake

April 29 2009 ~ "f you are a parasite/pathogen, it pays not to kill your host..."

"We are all really awaiting the sequencing data from CDC (US Centers for Disease Control) then we may have a handle on what this virus is all about."Dr Colin Fink (Micropathology Ltd) writes to warmwell.com today:

"It does seem strange that it has been associated with a high mortality in Mexico but not so far elsewhere. One has to ask whether the deaths are primary 'flu deaths ( as in the 1919 outbreak which killed fit young people in 3 - 4 days) or whether these deaths are in a group who have suboptimal nutrition and may have had secondary ( or existing) bacterial infections which were the cause of the mortality? Another possibility is the presence for more than one strain but still H1N1 . One not very easy for humans to catch except by close contact with pigs, but very pathogenic in humans, and the other far more easily transferred between man and man but much less virulent. If you are a parasite/pathogen, it pays not to kill your host - your chances of genetic persistence (what each species is about) are diminished if you kill the vehicle. Most new pathogens which jump species, recognise this maxim and quickly become less virulent within the new species."

(The Google map of outbreaks (the UK now has 5 cases) can be seen here in a new window.)

April 29 2009 ~ H1N1: "What one would like to see is a professional and independent analysis of the methodologies currently being used, as well as methodologies that could be used but aren't."

Always aware of how sadly little integrated the controls for human and animal disease still are (it was in an article for warmwell.com in 2003 that Dr Ruth Watkins deplored the failure to apply methods in human medicine to the care of farm animals when on genetic analysis they are so similar), we note with interest this second H1N1 flu article from James Irvine's LandCare website. Wondering how long will be the wait for promised H1N1 test results he wrote,

" As in all outbreaks of viral diseases - be they in livestock or humans - speed and accuracy of diagnosis is of the utmost importance....Where are these tests being done, by whom and using what technologies?"

The public, "widely informed regarding the utilisation - or non-utilisation - of modern scientific advances" are aware of "the control - or lack of control - of the spread of Foot and Mouth Disease UK 2001" Is today's underfunded Pirbright ("at least partially responsible for the most recent Foot and Mouth Disease outbreak in the UK," he says) really able to contribute to " the management of the present impending crisis? Or is it still resisting the better integration between human and animal disease control in the field of virology?"

The article describes how 15,000 "squealing hogs" in 18 warehouses comprise the intensive pig production of in the Mexican town of Xaltepec

"The reports of swarming flies, terrible smells and pictures of rotting pigs left scattered around the perimeter of its industrialised pig farms in Mexico are echoes of the concerns that have long been troubling environmental activisits, campaigning against Smithfield in all the countries in which it operates, not least in the US. Critics say that - even on top of any questions about the humane treatment of the pigs - the sheer quantities of manure that have to be disposed of when thousands, or tens of thousands, of animals are housed together make it impossible to run this business in a safe way."

The article repeats the worry that confining pigs together risks diseases spreading fast, "a problem that farmers overcome by pumping the livestock full of vaccines and other drugs". An outbreak of Classical swine fever in Romania cost Smithfield $13m. One wonders if the present crisis can be instrumental in putting an end to these practices. See also below and today's letters in the Guardian

Wednesday April 29 2009 ~ H1N1: "The analysis of Dr. Rabadan and
colleagues is surprising..."

ProMed here refers to the statement sent to Promed by Raul Rabadan, PhD
of
Columbia University College of Physicians and Surgeons in New York which says,

"...We are puzzled about sources of information that affirm that the
virus is a reassortment of avian, human and swine viruses. It is true
that the H3N2 swine virus from 1998 and 1999 is a triple reassortant,
but all the related isolates are found since then in swine."

" in view of previous statements which have
gained currency that the genome of this virus is comprised of
components derived directly from avian, human and swine sources. We
look forward to seeing a detailed account of this new analysis."

If the deaths in Mexico (suspected total now 159 this morning) really are deaths from flu alone rather than secondary bacterial infections perhaps exacerbated by poverty, the mystery of why the virus is so much more virulent there remains. Dr Irvine's suggestion below that it may have been in Mexico for a lot longer than is apparent seems likely - and although the flu season in the UK is over, H1N1 may well come back with a vengeance in the Autumn. As the moderator in this ProMed posting says,

"the second wave can be more
pathogenic than the first wave, and inclusion of the present virus in
the vaccine for the autumn therefore should have the highest priority
(I am sure it does)"

April 27/28 2009 ~ First suspected cases of H1N1 in Germany (tests returned negative)

Many thanks to Sabine for this link (in German).
2 people have been isolated in Bielefeld on suspicion of having flu after returning from Mexico. A third person is said to have contracted the disease. Lab results to confirm/rule out H1N1 should be available tonight.Yahoo news is reporting suspected cases in Spain, New Zealand, France, Israel.WHO is coordinating the global response and is not advising travel restrictions.
Latest information - unsensational - is best read on ProMed.

April 27 2009 ~ "Influenza A (H1N1) virus, human"

ProMed is the best place to read the true situation with what journalists are calling "swine flu". The latest posting is here with links at the bottom to previous ones. ProMed moderators are agreed that "swine flu" is a misnomer:

"ProMED-mail's veterinary and viral disease moderators have discussed the
nomenclature of this condition, and have agreed that we should refer to it
in the titles of postings as "Influenza A (H1N1) virus, human", omitting
the word "swine". For now, at least, that is what we will do, amending the
titles of earlier postings in this thread (as shown in the "see also"
section below)."

There is currently no evidence that the disease is circulating in pigs.

April 26 2009 ~WHO's current pandemic alert phase
is still at level 3

ProMed has summarised the latest information on the Mexican 'swine' flu.

".... a meeting of the Emergency
Committee, (defined) the H1N1 (also known as "swine flu") outbreak a "public
health emergency of international concern". The current pandemic alert phase
is still at level 3 (see the chart with pandemic alert phases available at
http://www.who.int/csr/disease/avian_influenza/phase/en/index.html with
a suggestion that this.. may be altered depending
upon how the situation progresses...
USA.. .. there have been 11 cases confirmed thus far by the CDC... full recovery..."

In Mexico there are now 1324 known cases (it was about 1000 less than 24 hours
ago) There are now 81 reported deaths. No reason for the
disparity in severity between Mexico and the US is apparent.

April 26 2009~ " a reminder that Mother Nature is still the
most skilled bioterrorist out there.."

ProMed says that although
there does seem to be "significant human to human transmission" it is unclear " if any measures could have been
effectively implemented that would have interrupted transmission earlier.... a reminder that mother nature is still the
most skilled bioterrorist out there.." Read in full. None of the US cases is linked to known exposures to either swine or poultry.
ProMed's posting (03) deplores the usual crying of wolf at such times in the press.

"....."spin
doctors" are casting stones, blaming cover-ups and slow responses as
responsible for the outbreak "escaping", and rumors of implicated swine
production farms as the foci where the outbreak allegedly began -- an
unfortunate situation that seems to repeat itself every time there is a
major outbreak with many unknowns."

April 26 2009 ~ Concern mounts that the new Mexican 'swine' flu strain could cause a pandemic

(See also latest swine flu news from Google) This is universally referred to as "swine" flu, but ProMed points out that there have not been
any cases in pigs yet, adding in a second posting that "it is too early to
conclude that this virus has originated in swine".
. However, this new and unusual strain of H1N1 swine flu has killed at least 20 people and possibly 48 more in Mexico and it genetically matches eight mild cases first identified in California and Texas. There are suspected cases in Canada. Reuters reports that the World Health Organization warned on Saturday that this strain could cause a pandemic.

"...World Health Organization director Dr. Margaret Chan has said the strain of H1N1, a new combination of porcine, fowl and human flu virus strains, has the potential to become a pandemic strain because it does spread easily and does cause serious disease...CDC (US Centers for Disease Control)
experts note that while it is possible to contain an outbreak of disease that is in one limited area, once it is reported in widespread locations, the spread is impossible to control.."

The WHO's pandemic alert level is currently at 3 on a scale of 1 to 6 - but may now be raised. So far, pigs are not officially implicated, but the EU has now declared a ban on the imports of pig products from Mexico.
We understand there are now suspect cases in both Switzerland and the Netherlands.